What does it mean if there is no reaction to Mantoux?

When the doctor tells the parents that the child has positive reaction Mantoux, they have a number of questions about how good or bad it is. In order to correctly perceive the words of a health worker, it is worth delving into the principle of determining tuberculosis infection using a tuberculin test.

Which reaction is better: negative or positive?

After a tuberculosis test (Mantoux test), 72 hours must pass before the result can be determined. The assessment involves measuring the papule - a knob-shaped compaction that forms at the site of injection of the drug. What does this assessment mean and what does the papule look like if the child has a positive or negative result?

The following types of test results are distinguished:

1. A negative Mantoux reaction is the absence of compaction or redness around the injection site. This usually indicates complete absence contacts with mycobacteria. But for doctors, such a result can serve as a signal to carry out another vaccination against tuberculosis.
2. A questionable Mantoux reaction is observed when there is a possible presence in the body small quantity tuberculosis bacilli, but sometimes occurs when the test is performed incorrectly, low-quality tuberculin is used, or the rules of care for the injection site are not followed. The papule in this case reaches a size of 1-4 mm. A repeat test may be prescribed to clarify the result.
3. A positive reaction to Mantoux is characterized by the formation of a compaction of 5-10 mm. If the sample is even larger (17 mm) or there is suppuration, then the reaction is called hyperergic. This worst result of the possible. Positive and hyperergic reactions most likely indicate that a person has become infected with tuberculosis or even the onset of the disease. A bad Mantoux is especially alarming to doctors if all previous tests gave a negative result.

But positive result is not a sentence. In some cases, the appearance of a large papule is considered normal.

When not to worry

After vaccination or revaccination (vaccination against tuberculosis), a positive Mantoux reaction in a child can be observed due to the fact that the body produces antibodies to the tuberculosis bacillus. The preparation for the Mantoux test, or tuberculin, contains a certain amount of waste products and cell membranes of mycobacteria. Due to the recognition of the protein of bacteria as pathogens themselves, the child’s body begins to direct to the site of tuberculin injection a large number of leukocytes. Protective cells provoke local inflammation and lead to the formation of compaction.

If a positive reaction occurs in the first year after vaccination, this means that the BCG vaccine has begun to act. The child’s body will be protected from tuberculosis, and bacteria that accidentally enter it will receive an adequate response immune system.

The question of what to do when the Mantoux reaction is negative and what this means is such a case the doctor must decide. For parents, a negative Mantoux result in the first year after vaccination means that for some reason the child has not received immunity and they should be careful about their contacts with relatives and other adults. Mycobacterium tuberculosis can be easily transmitted by airborne droplets, end up on household items or in street dust.

But what to do if the Mantoux reaction is positive and this is not related to a recent tuberculosis vaccination? In this case, you should not worry yourself and make the child nervous: if vaccination was not carried out (at the request of the parents or due to other reasons), then a positive reaction only indicates the penetration of microbes into the body. With a strong immune system and good general condition the child may not develop the disease. This means that mycobacteria live in the body in a latent form.

The danger of this condition is that when the immune system is weakened due to external cause(stress, infection, etc.) the development of tuberculosis may begin. To determine this in time, tests are carried out annually until the age of 18 years (the Mantoux test is usually not performed in adults). If necessary, the pediatrician will give a referral to an appointment with a phthisiatrician or a tuberculosis clinic. The child will be prescribed additional examinations and treatment.

If the Mantoux reaction becomes smaller

Immunity after vaccination lasts for 7-8 years. When performing the Mantoux test annually, you can notice a gradual decrease in the papule. This indicates that mycobacteria have not entered the body, and the immune response becomes weaker every year. To restore immunity against tuberculosis, the child is given 2 BCG revaccinations: at 7 and 14 years of age.

After these vaccinations, an increase in the papule should again be observed after 1 year, and then a gradual decrease in the result with the next test. But a child at school begins to actively contact children and adults, among whom there may be carriers of mycobacteria.

What is a turn during the Mantoux test?

If the tuberculosis pathogen enters the body with immunity obtained as a result of the BCG vaccination, then the immune system copes with it on its own. The disease does not develop, but during the next annual test a positive or bad Mantoux reaction appears. Often in such cases, the size of the papule differs from the previous result by 6 mm or more, or the usual negative Mantoux test becomes positive. This result is called the turn of the tuberculin test. What does this reaction of the body mean?

Turning is a sign of tuberculosis infection. With a developed immune system, the disease may not begin.

Nevertheless, if a deviation is detected, the pediatrician gives a referral for examination by a phthisiatrician. The child can be registered at a tuberculosis dispensary and his condition monitored to determine whether a local process is developing in the body. If a specialist prescribes medication, then his instructions must be followed precisely and strictly: treatment helps the body better cope with mycobacteria initial stage development of the disease.

What can affect the Mantoux result?

So that the Mantoux test gives reliable result, it is prohibited to carry it out on the day when vaccinations against other diseases are given. When using vaccines with inactivated microbes and viruses (influenza, tetanus or diphtheria vaccinations), the Mantoux test is allowed only after 30 days. Live vaccines (hepatitis, measles or rubella) require testing no earlier than 45 days after vaccination.

Before carrying out the test, the pediatrician must examine the baby. If the child is sick with ARVI, then the procedure cannot be performed: the Mantoux test in such a case can give a positive result, regardless of the presence of Mycobacterium tuberculosis in the body. The test is postponed to another date. At least 30 days must pass between the child’s recovery and the Mantoux test.

There are also direct contraindications for performing a tuberculin test:

• identified allergy to the drug;
• exacerbation seasonal allergies to pollen or the presence of other allergic reactions (to wool, food, etc.);
• infectious diseases in the acute phase;
• dermatological diseases;
• Sokolsky's disease;
• asthma;
• epilepsy.

If the child attends childcare facility, then the Mantoux test is not performed during quarantine and for 1 month after its removal.

The results of the tuberculin test can also be affected by violation of the rules of care for the injection site.

Parents who bring their child to the clinic on their own are given information by their local pediatrician. When performing the test in kindergarten educators are required to notify parents that children have had a Mantoux test done. Within 72 hours after injection it is not recommended to:

• rub the injection site with a washcloth or towel;
• cover it with a band-aid;
• lubricate antiseptic solutions(brilliant greens, iodine, etc.);
• wear clothes that put pressure on the skin (sweaters, turtlenecks);
• In the summer, you should refrain from swimming in open water.

If the rules are violated or the injection site is accidentally injured, a false positive test Mantoux, which will cause the doctor to react in the same way as when receiving a positive reaction to the test. Parents should notify the doctor about factors that distort the result.

If a positive result of a tuberculin test is not a consequence of violations during its implementation, then a phthisiatrician should make a conclusion about the child’s condition. To determine the onset of the disease or infection with tuberculosis, fluorography may be prescribed chest, sputum examination and other tests. All family members must be tested to determine the source of infection.

IN childhood The disease may begin unnoticed but progress rapidly to clinical form. Therefore, conducting annual tuberculin tests is a necessity, and not an invention of unknown enemies of the state. You should not be afraid of performing the Mantoux test, nor should you have a negative attitude towards it: there are no living or killed bacteria in the preparation. Tuberculin contains only protein substances, by which the body recognizes pathogenic microorganisms.

The mantoux test helps to identify a tendency to tuberculosis. A special solution is injected under the skin, which attracts Koch's rods to itself, revealing their number. The reaction to the introduction of the solution may be different, depending on the number of pathogenic bacilli in the child’s body. Let's consider the topic: negative mantoux reaction in children.

Reaction to tuberculin

All healthy babies are vaccinated against tuberculosis after birth. This is due to the prevalence of tuberculosis infection among the human population. In the first days and months of life, the baby’s immune system cannot protect him from dangerous bacteria Therefore, one of the first vaccinations is BCG. If an adult can cope with an infection, then for a newborn baby it is dangerous to communicate with a person infected with tuberculosis (a carrier of Koch bacilli).

What solution is administered to identify Koch bacilli in the child’s body? For this purpose, highly diluted tuberculin is used, which contains killed mycobacterium tuberculosis. When this composition is introduced under the skin, a peculiar allergic reaction in the form of compaction (infiltrate) and redness. Using these indicators, the doctor assesses the resistance of the immune system to infection.

Why is the mantu test carried out repeatedly? Because a stable immune response of the body is not formed immediately and depends on several factors:

• child's immune strength;
• the quality of the vaccine itself.

A year later, the baby is given the first mantu test to check the immune system’s response to the pathogen. However this sample does not reveal the whole picture of the child’s body’s defense against infection, because immune defense is in the formative stage. Therefore, the test is done repeatedly.

Important! The Mantoux test is given to a child every year until he turns 14 years old. After this, parents can independently contact the clinic to determine the health status of their child in case of any suspicion of infection.

Negative answer

The reaction to tuberculin can be positive or negative. A negative test means that there are no dangerous Koch bacilli in the child’s body, and there is no need to worry. If the answer is positive, a strong infiltrate and redness will form. A positive answer may mean:

• the child’s body faced the attack of infection and coped;
• The child’s body is infected with Koch’s bacillus and needs treatment.

Which test is considered negative? A test is negative if a small “button” no larger than a millimeter is formed at the injection site. If the answer is negative, no redness will form around the “button”.

If the response to the solution is positive, a compaction of up to 16 mm is formed. around the puncture site. If the answer is positive, the doctor states that the child’s body copes quite adequately with the attack of infection.

Important! A positive Mantoux reaction in the absence of BCG vaccination may indicate that the child is infected with tuberculosis.

If the reaction remains negative at 7 or 14 years of age, the child is revaccinated with BCG. A negative answer means that the body has not developed immune bodies against tuberculosis. This occurs in the event of either a violation in the vaccination procedure, or in the case of a poor-quality vaccine.

If the answer is positive (“button” from 3 to 10 mm in diameter), BCG revaccination is not carried out, since the vaccine tends to stabilize immunity to the irritant for up to seven years.

A positive response

Worried parents are terrified of reactions to the mantoux test and begin to independently measure the entire radius of redness with a ruler. However, only the “button” itself, that is, the compacted area around the injection, is subject to measurement.

Is a negative response to manta always normal? It turns out not. A positive reaction indicates a struggle between the baby’s immune forces and the introduced microbes in the BCG vaccination. If the reaction is constantly negative, then the vaccinations were ineffective. Therefore, the doctor will find out the circumstances of the negative response to manta.

Important! If the Mantoux test was negative at 7 years of age, the child is given a second BCG vaccination.

When is manta not made?

Vaccinations have many opponents who consider them dangerous to the health of children. However, we should not forget: vaccinations saved humanity from terrible infections - cholera, plague and smallpox. If you are anti-vaxxer, find a worthy alternative BCG vaccinations and Mantoux test. For this there are paid analyzes blood for immunoglobulin to tuberculosis.

Also, the mantoux test is contraindicated for:

• colds and runny nose;
• exacerbation of infectious diseases;
• severe allergy to the components of the solution;
• other pathological health conditions.

Also, manta is not given together with other preventive vaccinations for safety reasons. It is important to remember that a test for infection with the tuberculosis bacillus can be done only a month after recovery from any illness.

When should you worry?

Parents tend to worry about any reaction to manta rays - positive or negative. This is quite justified, because both reactions can pose a health threat. If the reaction showed a deviation from the permissible level, this does not yet indicate tuberculosis. The child is not at risk. However, it should be noted that a child who has:

• hyperergic reaction to manta ray;
• a bubble has formed at the puncture site;
• constant negative reaction to the test;
• The diameter of the “button” increases over the years.

In these cases, the baby is given an x-ray to identify the clinical picture of deviations in the Mantoux test. A doctor’s referral to a phthisiatrician does not mean the baby has tuberculosis: they are sent to him for clarification clinical picture at questionable results mantu samples.

Can tuberculin administration harm a baby? Mantoux is not a vaccine. This is testing the immune system for resistance. The tuberculin solution stimulates the immune system and reveals the presence of immune bodies in the body.

Mantoux reaction: what result is considered normal?
How are the results of the mantoux test evaluated? Mantoux test: why do it to a child, is it dangerous? If there are no contraindications, mantoux test best test for tuberculosis
Reaction to manta ray in a child at different ages Mantoux vaccination side effects their cause and prevention

Sometimes, after a tuberculosis vaccination, a negative Mantoux reaction occurs. Theoretically, the child does not have a tubercle bacilli that will react with the vaccine. But doctors are of two minds about this.

The reaction may not appear, although the presence of infection is present. In this case, long discussions and disputes arise. In this case, the child’s body may be weakened and does not cope well with infectious agents. Consequently, this is a very acute problem that cannot be ignored by either doctors or parents.

What is Mantoux?

In order to properly understand whether negative Mantoux in children is good or bad, you first need to understand all the stages of the Koch wand test.

Vaccination is based on a drug called tuberculin. And when it is injected onto the inner surface of the forearm. A so-called “button” or “papule” forms on the skin. Three days later, a Mantoux test is done. And, depending on the size of the button, doctors observe the body’s reaction. That is, the larger the button, the more alarming the symptoms.

The absence of a button should be considered as the absence of a tuberculosis bacillus. But this is if a BCG vaccination was given first with a tuberculin test.

BCG is the very first vaccination that is given from birth. It helps strengthen the immune system and prepare the body for further stress. After the vaccine has been given, three days must pass before a doctor or nurse takes samples. And for this they will need a ruler:

• If the size of the button is more than 17 mm, then you should immediately additional tests, since this is the highest point of the body’s response to the vaccine;
• Seal size from 5 to 16 mm. indicates that the reaction to Mantoux is positive;
• If the seal is less than 4 cm in size, or has redness, then the reaction is considered doubtful;
• Button, size 1 mm. and less is a negative reaction.

Contraindications

Before you do the test, know in what cases such vaccination is not done:

1. Intolerance of the body to certain enzymes in the composition (for example phenol);
2. Epileptic seizures in a child;
3. Epidermal pathologies and abnormalities;
4. Colds. As well as the presence of another inflammatory infection.

Factors that influence results

In addition to contraindications, the size of the buttons can be affected external factors, which will then distort the results:

1. Before vaccinating, the doctor must find out whether other vaccinations have been given before. And if they were, then it is best to pause between vaccinations (a month);
2. The button must not be wet;
3. After the Mantoux test, this place cannot be interacted with other means;
4. Also, you can’t wrap it or scratch it. About the fact that the button can’t be wet. Some parents do not fully understand this point and then misunderstandings arise. Remember that hygiene should not be neglected. The button should not be wet, but the rest of the body can.

If a negative Mantoux reaction occurs

Negative Mantoux in children can be both positive and negative character. But at the same time, infectious bodies may be in a “frozen” state and are ready to express themselves at any moment.

Doctors also believe that this may indicate a lack of immunity, because there is no accumulation of lymphocytes in the area of ​​the injection. And in this case, the child is predisposed to the disease. But there is no need to sound the alarm in advance, since there is re-vaccination. And if next time the reaction is negative, then additional tests should be taken.

In addition to a negative reaction (or even a false reaction), there may be other reasons:

• If the child has been infected with the tuberculosis bacillus in the last few weeks (in this case, a second vaccination should be given after 10 weeks);
• Because of children's body does not immediately begin to fight back the infection, there may also be a negative reaction, and this may also be affected weak body who has difficulty coping with illnesses;
• Diseases that are associated with disorders of the immune system (for example, AIDS) (in this case, additional diagnostics, and the Mantoux test is done with an increased dose of tuberculin).

If the Mantoux reaction is positive

If the body reacts positively to tuberculosis, the child may develop severe lumps and redness. This indicates that the body met a powerful attack from the virus and valiantly repelled it.

Many parents, having seen redness, begin to independently measure the place of redness with a ruler, not knowing that it is not the seal that needs to be measured, but the button itself. And in any case, do not panic, but seek help from a doctor.

But, in the case when the Mantoux reaction remains very negative for a long time, this suggests that the vaccinations did not produce any results. And it is necessary to pass full diagnostics for tuberculosis. If a child under 14 years of age remains negative for tuberculin, then he is re-vaccinated with BCG.

Virus of tuberculin test

This concept means that the reaction to Koch's bacillus changes sharply in the opposite direction compared to previous vaccinations. However, re-vaccination with BCG was not carried out. That is, the body showed that there was no disease inside, and here you have it! This means only one thing: that the child is infected with tuberculosis.

Parents about the safety of phenol

Some parents refuse to do a Koch test for one reason. Having surfed dubious forums and read the composition of the solution, they believe that one of the substances in the tuberculin test, phenol, is dangerous and toxic to the life of a child. But that's not true. Any doctor will explain to you that this substance is a natural metabolic product. And this substance is present in any animal or human body.

And in solution, phenol is a preservative and its doses are so insignificant that they simply cannot poison the body of even an infant. Doctors summarize statistics and give an example for parents who doubt the effectiveness of the drug. To really poison the human body, you need to do at least 1000 vaccinations.

When to sound the alarm

Parents tend to panic in any situation. There is a positive reaction to Mantoux. The child has no reaction to Mantoux. All tests give a 100% result only after several tests, over a period of several years. It is impossible to say for sure after the first test that the child has tuberculosis. But there are symptoms in which the child definitely needs to be seen by a TB specialist if:

• There is a hyperegic reaction to the Koch bacillus test;
• A watery blister appeared at the injection site;
• Annual manifestation of a negative reaction to Mantoux;
• Every year the button increases in size.

In this case, the child is sent for an x-ray to identify full picture deviations.

Prevention of tuberculosis

In case of any reaction of the body to tuberculin, it is important to know that tuberculosis mainly affects those children who have reduced immunity. And if a child becomes infected with Koch’s bacillus, then he is seen by a doctor and the doctor decides how to treat this disease. But while there is no virus, there are a number of preventive measures, which are aimed at strengthening the immune system and increasing the body's resistance to this disease.

The most common type of health promotion is sports. That being said, if you're not a big fan. physical activity, then morning and evening walks on the fresh air. But for general strengthening immune system, it is best to engage in some kind of sport. Anything will do: hiking, kayaking, running, hardening, etc.

The house must be kept clean and tidy. Ventilate the room, do wet cleaning and also eat well. That is, the diet should include all the vitamins and microelements necessary for the body. For adults, smoking and drinking typically weaken the immune system, allowing infections to multiply in the body. By at least, doctors recommend limiting yourself to these weaknesses.

If someone in the family becomes ill with tuberculosis, then it is necessary to isolate him from other family members and allocate a separate room or apartment. At the same time, in the room where the patient is located, it is also necessary to periodically do wet cleaning and ventilate the room. It is the protection of the patient from other people that will reduce the risk of infection with Koch's bacillus. To do this, the patient must receive sick leave at the workplace, and it is best for the child to stop attending educational institutions.

And most importantly, doctors are obliged to increase the literacy of the population regarding this disease. Ask your doctor about treatment and prevention methods for tuberculosis. If you have the slightest symptoms, consult your doctor. And also undergo annual fluorography.

Conclusions about the negative sample

The main thing that scares modern parents The problem is that they often confuse testing with vaccination. The main thing to remember is that Mantoux is not a vaccine. It is absolutely safe if you follow all the rules for transporting the vaccine and the expiration date. Now there are other types of tests, and they do not even need to be administered annually. So if you doubt the results, you can always choose a different path. Remember to consult your doctor and monitor your health and the health of your child.

The merciless fight against tuberculosis is not only about treatment in specialized clinics for those suffering dangerous illness, but also early detection of a tendency to the disease.

This is especially acute for children. The Mantoux test successfully copes with the task, which is started for children with one year old.

Mantoux reaction - what is it?

More than a hundred years ago, in 1882, humanity learned of the existence of the tuberculosis “Koch bacillus,” named after the German microbiologist who discovered it. Looking for effective remedy from an unknown disease, Robert Koch, like other researchers around the world, conducted numerous experiments, which resulted in the creation of tuberculin. Despite the hopes placed on it, the drug turned out to be powerless in the fight against tuberculosis, but its discovery was not in vain. In 1908, a physician from France, Charles Mantoux, discovered a difference in the reaction of healthy and tuberculosis patients to the administration of the drug. His discovery marked the beginning of the use of tuberculin as a test for the presence of a dangerous bacillus in the body, and the research method itself was called the Mantoux test.

The annual Mantoux test involves injecting small doses of tuberculin under the child’s skin and monitoring the body’s reaction to this procedure. At the injection site there may be slight inflammation, due to the presence of active lymphocytes. They are responsible for anti-tuberculosis immunity, and their quantity affects the resulting reaction. 72 hours after administration of the drug, the doctor examines the injection site and renders his verdict. The result depends on the presence or absence of inflammation and the size of the compaction.

How often is the Mantoux test performed on children?

On the fourth to seventh day after the baby is born, he is given the BCG vaccine, designed to build immunity against tuberculosis. Exactly one year later, the first Mantoux reaction is carried out, which shows how the child’s immune system behaves when encountering a tuberculosis infection. Before the baby celebrates his first birthday, the Mantoux test is not done, as the result may be incorrect. In the future, it is carried out every year until the age of 14.

If the BCG vaccination was not given, due to various reasons, done on time, further vaccination depends on the Mantoux reaction - a negative result confirms the absence of the tuberculosis bacillus in the body and indicates the relevance of the BCG vaccination. Positive, if it is within normal limits, confirms the fact of the encounter with the Koch bacillus and the victory of the immune system over it. In this case, there is no point in carrying out vaccination, but it is advisable to do the Mantoux test on a schedule, annually.

How to care for the Mantoux test in children

The Mantoux test is done for children in the clinic - the drug is injected into the arm. To obtain correct result, you should follow some simple rules. The resulting “button” cannot be:

- seal with adhesive tape;

- lubricate with brilliant green or hydrogen peroxide;

- wrap tightly with clothing or a bandage;

- in case of accidental contact with water or other liquid, rub with a towel - just blot it gently.

It is advisable to exclude from the baby’s diet foods that can cause allergies - chocolate, lemons, oranges.

What does the Mantoux reaction mean and when should mom not worry?

After three days, the doctor will evaluate the result. An impatient mom can do this on her own to cope with understandable anxiety. Several variants of the Mantoux reaction are possible.

Negative Mantoux reaction in children

The Mantoux reaction in children is considered negative if the size of the “button” is no more than 1 mm and there is no redness around it. Mom can breathe easy, the baby has absolutely normal reaction.

Positive Mantoux test in children

How positive is the Mantoux reaction in children, in which the compaction at the injection site is from 5 to 16 millimeters. This usually indicates that after vaccination with BCG, the immune system reacts quite adequately to the danger. If the baby is not vaccinated, such a reaction may indicate that the child has a tuberculosis bacillus. Don’t panic right away; this fact does not at all indicate that the child is sick and needs to be hospitalized urgently. It’s just that Koch’s wand, under certain conditions, can become active, and then the help of a doctor will be needed. Therefore, such children need to be monitored, and, if necessary, the pediatrician will refer the child to a phthisiatrician.

Hyperergic Mantoux reaction in children

Hyperergic is a type of positive reaction. The compaction can reach 17 millimeters or more, and ulcers and ulcers appear at the injection site. The result is not very comforting - most likely, the fragile child’s body is attacking great amount dangerous bacteria. The likelihood of contracting tuberculosis in this case is very high.

False-positive Mantoux test in children

A false positive can scare the mother to death, although the cause may be improper care of the injection site. However, for more accurate diagnosis, as in the case of a positive reaction, the baby is sent to a TB specialist for consultation and additional examination.

Questionable Mantoux reaction

A reaction is considered doubtful when there is only redness of the skin or an increase in compaction up to 4 millimeters. Further annual monitoring will allow us to make correct conclusion. There's nothing to worry about for now.

Attention! You do not need to measure the entire reddened area, but only the “button”.

Side effects of the Mantoux test in children

As a rule, against the background of a recent illness or in the presence of allergies, an unexpected reaction to the Mantoux test may occur. Symptoms usually occur suddenly:

• heat, sometimes up to 40 degrees, and fever;
• skin rashes- can be not only on the arm, but also in the groin, on the butt, under the knees, on the face;
• weakness;
• refusal to eat;
• itching in the injection area;
• vomit;
• headache.

In such a situation, it is necessary to call a doctor at home, he will examine the baby and prescribe histamines.

Mantoux reaction - do or refuse

The Mantoux reaction test is not a vaccination, so parents can refuse it if they wish. You should carefully weigh the pros and cons - after all, the health of the child depends on your choice. The risk of contracting a dangerous disease is quite real, therefore, when deciding to refuse the Mantoux reaction, try to find an alternative. Many private clinics do a special blood test - immunoglobulin AMg for tuberculosis. Of course, you will have to pay for it, but it’s still better than leaving the baby alone with a possible serious disease.

Sometimes the Mantoux test is not done according to medical indications. The doctor will refuse to perform it if the baby has:

• cough and runny nose;

• allergy;

• skin diseases;

• epilepsy;

• exacerbation of a chronic illness;

• acute infectious disease.

The Mantoux test should not be given to a child at the same time as other vaccinations, otherwise the result may be false positive.

Risk zone

There are a number of conditions under which a child after a Mantoux reaction can be included in the so-called risk group for tuberculosis. This does not mean that he is sick, but the baby needs additional examination and supervision by a phthisiatrist. Indications:

1. Hyperergic reaction;

2. A compaction at the injection site of 5-16 millimeters, together with a reddish mark along the lymphatic vessel or a vesicle at the injection site;

3. No decrease in Mantoux test with age;

4. The size of the “button” has increased significantly compared to last year.

Additional examination will help confirm or refute the development of tuberculosis.

Mantoux test - is there an alternative?

Some mothers have heard about the emergence of a new drug, which is supposedly a substitute for the Mantoux test. Diaskintest appeared several years ago and is successfully used in the diagnosis of tuberculosis. However, this is just additional method examinations, which in no case replace a long-proven method. The drug is not able to assess the effect of the immune system after vaccination with BCG, cannot suggest the need for re-vaccination at seven years of age, and does not respond to bovine mycobacterium. In addition, if the Mantoux reaction is positive already at the stage of introduction of the Koch bacillus, then Diaskintest reacts only to its activation in the body and to changes in the lymph nodes and lungs. When the question is about the formidable and dangerous disease, you can't waste precious time. Therefore, the Mantoux test is used throughout the world for mass examination.

What does Doctor Komarovsky say about the Mantoux test in children?

1. Evgeniy Komarovsky considers the Mantoux test to be the most effective method today for determining the presence of tuberculosis bacillus, which should never be neglected. He calls signs of possible infection:

• tuberculin test variation, when a negative result becomes positive without BCG vaccination;

• a hyperergic reaction, in which the size of the papule, instead of decreasing, exceeds 12 millimeters for four years in a row.

2. Dispelling the fears of many mothers about the toxic phenol content in tuberculin, he explains that this component is a natural product of human metabolism, so there is no need to be afraid of it. Moreover, its content as a preservative is so negligible that it cannot harm the baby. In order for it to really have a toxic effect, it would be necessary to give the baby a thousand Mantoux tests at the same time.

3. Regarding alternative uses Diaskintest, Dr. Komarovsky emphasized that the Mantoux test is used all over the world as the most effective indicator. New test doesn't respond to BCG vaccination, therefore, a positive reaction to its conduct indicates the presence of tuberculosis.

Tuberculin test(Mantoux reaction - intradermal, Pirquet test - cutaneous, Koch test - subcutaneous) - a test to determine the specific sensitivity of the body to mycobacterium tuberculosis. This test shows whether the body has tuberculosis infection. The main method of early detection of tuberculosis in children and adolescents is the annual tuberculin test - intradermal Mantoux test.

The Mantoux test is not a vaccine, so it is not on the list of preventive vaccinations; it is a kind of skin allergy test.

If a person has at least once been in contact with tuberculosis bacilli, then in his body there are cells of the immune system (lymphocytes) that “remember” Mycobacterium tuberculosis and when new meeting it triggers a powerful immune reaction designed to destroy foreign material.

The principle of operation of the Mantoux test (reaction) is to provoke an inflammatory-allergic reaction with the help of a specific substance tuberculin, a structural component of Koch bacilli (the causative agent of tuberculosis, Mycobacterium tuberculosis).

When is the Mantoux test performed?

In accordance with the Order of the Ministry of Health and Social Development of the Russian Federation dated March 21, 2003 No. 109 “On improving anti-tuberculosis measures in the Russian Federation” (as amended on October 29, 2009 N 855), the Mantoux test is given to all children vaccinated against tuberculosis from 12 months of age and adolescents annually (once a year) regardless of the previous result.

Children over 2 months of age require a preliminary Mantoux test before vaccination with BCG-M. Children with a negative reaction to tuberculin are vaccinated. The reaction is considered negative in the complete absence of infiltration (hyperemia) or the presence of a prick reaction (1.0 mm). The interval between the Mantoux test and vaccination should be at least 3 days and no more than 2 weeks.

The Mantoux test is given to the following children 2 times a year:

• children not vaccinated against tuberculosis due to medical contraindications, as well as not vaccinated against tuberculosis due to parental refusal to immunize the child, before the child receives vaccination against tuberculosis. ( resolution of October 22, 2013 N 60);
• sick diabetes mellitus, peptic ulcer, blood diseases, systemic diseases, HIV-infected people receiving long-term hormone therapy(more than 1 month);
• with chronic nonspecific diseases (pneumonia, bronchitis, tonsillitis), low-grade fever of unknown etiology;
• not vaccinated with BCG vaccine during the neonatal period, while maintaining medical contraindications Mantoux test is performed 2 times a year, starting from 6 months of age until the child receives vaccinations BCG vaccine-M, as well as not vaccinated against tuberculosis, regardless of the child’s age.

Contraindications to the Mantoux test

The Mantoux test (according to Order No. 109) with 2 TE PPD-L is harmless both for healthy children and adolescents, as well as for persons with various somatic diseases. However past illnesses and previous vaccinations can affect the sensitivity of the child’s skin to tuberculin, strengthening or weakening it. This complicates the subsequent interpretation of the dynamics of sensitivity to tuberculin and is the basis for determining the list of contraindications.

Contraindications for performing tuberculin tests with 2 TE during mass tuberculin diagnostics:

• skin diseases, acute and chronic infectious and somatic diseases(including epilepsy) during the period of exacerbation;
• allergic conditions, rheumatism in acute and subacute phases, bronchial asthma, idiosyncrasies (painful reactions that occur in some people in response to certain nonspecific (as opposed to allergies) irritants). with pronounced skin manifestations during the period of exacerbation.

In order to identify contraindications, the doctor ( nurse) before performing tuberculin tests, conducts a study medical documentation, as well as examination of the child. It is not allowed to carry out the Mantoux test in those children's groups where there is a quarantine for childhood infections. The Mantoux test is performed 1 month after disappearance clinical symptoms or immediately after the quarantine is lifted. Therefore, if your child has had an illness, for example ARVI or otitis media, the Mantoux test should be postponed for a month.

Preventive vaccinations and Mantoux test

Preventive vaccinations can affect sensitivity to tuberculin. Based on this, tuberculin diagnostics must be planned BEFORE carrying out preventive vaccinations against various infections(DPT, measles, etc.). In cases where, for one reason or another, the Mantoux test is performed not before, but after various preventive vaccinations, tuberculin diagnostics should be carried out no earlier than 1 month after vaccination.

Healthy children and adolescents infected with Mycobacterium tuberculosis, as well as with positive (doubtful) post-vaccination tuberculin sensitivity and children with a negative reaction to tuberculin, but not subject to BCG revaccination, all preventive vaccinations can be placed immediately after assessing the results of the Mantoux test. In case of establishing a “turn” of tuberculin reactions, as well as a hyperergic or intensifying reaction to tuberculin, without functional and local manifestations tuberculosis in children, preventive vaccinations are carried out no earlier than 6 months.

How and where is the Mantoux test performed?

For mass tuberculin diagnostics, only a single intradermal Mantoux tuberculin test is used with 2 tuberculin units (TU) of purified tuberculin per standard breeding(ready form).

To carry out the intradermal Mantoux test, one-gram disposable tuberculin syringes with thin short needles with a short oblique cut are used. The above order prohibits the use of syringes and needles that have expired, so the nurse must check their release date and expiration date before use.

The Mantoux test is performed on children and adolescents in a sitting position.

The Mantoux test is performed on the inner surface of the forearm: right and left forearm alternate. On the inner surface of the middle third of the forearm, the skin area is treated with 70° ethyl alcohol, dry with sterile cotton wool. A thin needle is inserted with the cut upward into the upper layers of the stretched skin (intradermal) parallel to its surface. After inserting the needle hole into the skin, 0.1 ml of tuberculin solution is injected from a syringe, i.e. one dose. With the correct technique, the skin forms papule in the form of a “lemon peel” not less than 7 - 9 mm in diameter, whitish in color. This specific bulging of the upper layer of skin is better known to everyone as a “button”.

What to do with the “button”?

The papule itself does not require any care. There is a very common misconception that “The Mantoux sample cannot be wetted!”. However, it is not. The Mantoux test, in contrast to the Pirquet skin test (when the integrity of surface layers skin in the form of a scratch), intradermal, and water does not enter instead of introducing tuberculin. Therefore, you can bathe your child, but do not rub him with a washcloth and preferably do not comb him.

After assessing the results, if necessary, the papule can be treated like any other wound, using antiseptics.

Evaluation of the results of the intradermal Mantoux test

The results of the tuberculin test are assessed by the doctor or specially trained nurse who performed the test. on day 3 (after 72 hours) by measuring the size of the infiltrate (papule) in millimeters (mm). A ruler with millimeter divisions measures the transverse (relative to the axis of the forearm) size of the infiltrate. Only the seal size is measured. Redness (hyperemia) around the lump is not a sign of immunity to tuberculosis or infection, but it is recorded when there is no papule.

The Mantoux test allows you to estimate three possible states human anti-tuberculosis immunity: normal immunity, lack of immunity and over-activated immunity.

Positive tuberculin test indicates the presence of Mycobacterium tuberculosis in the body and is observed during illness, infection and after intradermal immunization with BCG. However, one positive tuberculin test does not yet allow a diagnosis of tuberculosis, no matter how severe it may be. Even a sharply positive test can be observed in the absence of active tuberculosis. In such cases, it is a sign of a person’s increased susceptibility to the disease.

For the first time in life, a positive tuberculin test (“virage”) indicates a primary infection, the identification of which is very important in children and adolescents for carrying out measures to prevent the disease. A turn of the tuberculin reaction, accompanied by clinical manifestations, may be a manifestation of the disease, primary tuberculosis.

First positive reaction to tuberculin in a two to three year old child may be a manifestation post-vaccination allergy. When deciding on the need for observation in an anti-tuberculosis dispensary, it is necessary Objective assessment the child’s condition, collecting an anamnesis, as well as dynamic observation of the child with repeated tuberculin diagnostics after 3 months.

For negative reactions vaccination and revaccination are necessary.

Thus, the tuberculin test, having great importance in the diagnosis of tuberculosis in children and adolescents, is not an absolute criterion and can only be used in conjunction with other examination data.

The results of the Mantoux test in children and adolescents are recorded in accounting form No. 063/u, in medical card child (form No. 026/u) and in the history of the child’s development (form No. 112/u). At the same time, note: a) the enterprise - manufacturer of tuberculin, batch number, expiration date; b) date of the test; c) injection of the drug into the right or left forearm; d) test result - in the form of the size of the infiltrate (papule) in mm; in the absence of infiltration, indicate the size of hyperemia.

What can affect the results of the Mantoux test?

When interpreting the dynamics of sensitivity to tuberculin, one should also take into account that the intensity of reactions to the Mantoux test can be influenced by a number of factors that determine the overall reactivity of the body:

• the presence of somatic pathology (diseases of internal organs, such as the heart, liver, kidneys);
• general allergic mood of the body (tendency to allergic reactions); phase of the ovarian cycle in girls (the process of follicle maturation, ovulation and formation of the corpus luteum);
• individual nature of skin sensitivity;
• balanced nutrition of the child, etc.

The results of mass tuberculin diagnostics are strongly influenced by unfavorable environmental factors: increased background radiation, the presence of harmful emissions from chemical production, etc.

The results of tuberculin diagnostics can be influenced by various disorders in the methodology for its implementation:

• use of non-standard and low-quality tools,
• errors in the technique of performing and reading the results of the Mantoux test,
• violation of the transportation and storage of tuberculin.

In what cases are they referred to a tuberculosis clinic to see a phthisiatrician?

Interpretation of Mantoux test results:

A negative Mantoux reaction indicates that there are no lymphocytes in the body that have experience of communicating with the tuberculosis bacterium: no infection, no reaction to BCG vaccination;

A questionable sample is considered negative;

A positive test can be either a consequence of BCG vaccination or a sign of infection;

Signs of infection according to the results of tuberculin diagnostics include:

• turn of the tuberculin test;
• hyperergic reaction;
• persistent (more than 4 years) persistent reaction with a papule of 12 mm or more;
• a sharp increase in sensitivity to tuberculin (by 6 mm or more) within one year

Indications for referral to a phthisiatrician based on the results of the reaction to the Mantoux tuberculin test are:

• suspicion of a “bend” in tuberculin tests;
• hyperergic reaction;
• an increase in sensitivity to tuberculin with an increase in the size of the papules by 6 mm or more or the formation of an infiltrate with a diameter of 12 mm or more.

Children referred to a TB specialist must have the following information with them:

• about vaccination (BCG revaccination);
• on the results of tuberculin tests by year;
• about contact with a patient with tuberculosis;
• about fluorographic examination of the child’s environment;
• about past chronic and allergic diseases;
• about previous examinations by a TB specialist;
• clinical laboratory examination data ( general analysis blood and urine);
• conclusion of relevant specialists in the presence of concomitant pathology.

When a doctor decides whether a positive reaction to tuberculin in a child (adolescent) is associated with infection with Mycobacterium tuberculosis or whether it reflects a post-vaccination allergy, the following is taken into account:

• intensity of positive tuberculin reaction;
• number of BCG vaccinations received;
• presence and size of post-vaccination scars;
• period elapsed after vaccination;
• presence or absence of contact with a patient with tuberculosis;
• Availability clinical signs diseases.

Persons who, in the presence of reliable data on the dynamics of sensitivity to tuberculin using the Mantoux test, note the following are considered infected with Mycobacterium tuberculosis:

• for the first time a positive reaction (papule 5 mm or more) not associated with immunization with the BCG vaccine (“turn”);
• persistently (for 4 - 5 years) persistent reaction with an infiltrate of 12 mm or more; a sharp increase in sensitivity to tuberculin (by 6 mm or more) within one year (in tuberculin-positive children and adolescents);
• gradual, over several years, increased sensitivity to tuberculin with the formation of an infiltrate measuring 12 mm or more.

Increased sensitivity to tuberculin (including hyperergic reactions) in children and adolescents with somatic pathology, bacterial infection, allergic, frequent colds sometimes it is NOT associated with infection with Mycobacterium tuberculosis, but with the influence of the listed nonspecific factors.

If it is difficult to interpret the nature of sensitivity to tuberculin, children are also subject to preliminary observation in the “0” group of dispensary registration with mandatory treatment and prophylactic measures in the pediatric area (hyposensitization - a condition decreased sensitivity body to the allergen, as well as a set of measures aimed at reducing this sensitivity (sanitation of foci of infection, deworming, achieving a period of remission with chronic diseases) under the supervision of a pediatric TB specialist.

Repeated examination at the dispensary is carried out after 1 - 3 months. Decline after nonspecific treatment sensitivity to tuberculin indicates the nonspecific nature of the allergy.

Children with frequent clinical manifestations For nonspecific allergies, it is recommended that the test be performed while taking desensitizing agents ( medicinal substances, preventing or reducing the manifestations of allergies (for example, antihistamines) for 7 days (5 days before staging and 2 days after it). Maintaining sensitivity to tuberculin at the same level or its further increase, despite treatment and preventive measures, confirms the infectious nature of the allergy and requires further follow-up dispensary observation child.

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